Computer-Assisted Instrumentation during Endoscopic Transaxillary First Rib Resection for Thoracic Outlet Syndrome: A Safe Alternate Approach

Martinez, Bernardo D.; Wiegand, Catherine S.; Evans, Patricia; Gerhardinger, A.M.; Méndez, José

doi:10.2310/6670.2005.00094

Cited by 5 publications

(2 citation statements)

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“…The burgeoning field of minimally invasive surgery has recently impacted the treatment of TOS. Martinez et al () reported that starting in 2003 they used the robotic da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) for 42 patients to improve visualization during transaxillary rib resection, noting no mortalities or permanent neurovascular injuries in these patients. Abdellaoui et al () described an endoscopic technique for improved intrathoracic visualization, by making a 6–7 cm axillary incision and introducing a camera and instruments through the incision.…”

Section: The Future Of Tosmentioning

confidence: 99%

Thoracic outlet syndrome: A neurological and vascular disorder

et al. 2013

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Thoracic outlet syndrome (TOS) is a condition arising from compression of the subclavian vessels and/or brachial plexus as the structures travel from the thoracic outlet to the axilla. Despite the significant pathology associated with TOS, there remains some general disagreement among experts on the specific anatomy, etiology, and pathophysiology of the condition, presumably because of the wide variation in symptoms that manifest in presenting patients, and because of lack of a definitive gold standard for diagnosis. Symptoms associated with TOS have traditionally been divided into vascular and neurogenic categories, a distinction based on the underlying structure(s) implicated. Of the two, neurogenic TOS (nTOS) is more common, and typically presents as compression of the brachial plexus; primarily, but not exclusively, involving its lower trunk. Vascular TOS (vTOS) usually involves compression of the vessel, most commonly the subclavian artery or vein, or is secondary to thrombus formation in the venous vasculature. Any anatomical anomaly in the thoracic outlet has the potential to predispose a patient to TOS. Common anomalies include variations in the insertion of the anterior scalene muscle (ASM) or scalenus minimus muscle, the presence of a cervical rib or of fibrous and muscular bands, variations in insertion of pectoralis minor, and the presence of neurovascular structures, which follow an atypical course. A common diagnostic technique for vTOS is duplex imaging, which has generally replaced more invasive angiographic techniques. In cases of suspected nTOS, electrophysiological nerve studies and ASM blocks provide guidance when screening for patients likely to benefit from surgical decompression of TOS. Surgeons generally agree that the transaxillary approach allows the greatest field of view for first rib excision to relieve compressed vessels. Alternatively, a supraclavicular approach is favored for scalenotomies when the ASM impinges on surrounding structures. A combined supraclavicular and infraclavicular approach is preferred when a larger field of view is required. The future of TOS management must emphasize the improvement of available diagnostic and treatment techniques, and the development of a consensus gold standard for diagnosis. Helical computed tomography offers a three-dimensional view of the thoracic outlet, and may be valuable in the detection of anatomical variations, which may predispose patients to TOS. This review summarizes the history of TOS, the pertinent clinical and anatomical presentations of TOS, and the commonly used diagnostic and treatment techniques for the condition.

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Section: The Future Of Tosmentioning

confidence: 99%

Thoracic outlet syndrome: A neurological and vascular disorder

et al. 2013

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“…It appears that it is cheap, feasible, reproducible and valid. Furthermore, a training tool of realistic simulation on porcine model has been developed, which may be applicable to other endoscopic axillary procedures, such as thyroidectomy (41)(42)(43)(44)(45)(46)(47)(48), transthoracic sympathectomy (49), resection of the first rib for thoracic outlet syndrome (50) and plastic breast surgery (51,52).…”

Section: Discussionmentioning

confidence: 99%

Experimental model as training tool in endoscopic axillary dissection

Aponte-Rueda

Saade-Cárdenas

Navarrete-Aulestia

2010

Minimally Invasive Therapy & Allied Technologies

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Endoscopic axillary lymphatic dissection is a viable surgical option, but has not been taken with great enthusiasm; several factors have accounted for this, including the lack of an effective experimental model to acquire skills and abilities. The aim of this study was to develop a training tool for endoscopic axillary dissection and to evaluate its applicability in a porcine model. Twenty endoscopic dissections of the axilla were performed in ten female pigs of four to six months by a single surgeon with blunt dissection and CO(2). A surgical workflow was divided into temporal operative phases. Time necessary to perform this action was compared throughout the study. The mean dissection time was 26 +/- 7 minutes. The axillary content was separated from the other anatomical elements under complete visualization (85%). Intraoperative complications occurred in two dissections (10%). Residual fibrofatty tissue was removed from the axilla in three dissections. This data defined a pig model for commencement of training in endoscopic axillary dissection in the laboratory. Bringing these core elements together led to the development of a model for acquiring advanced laparoscopic skills, which may be applicable to other endoscopic axillary procedures.

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Robotics in vascular surgery

Martinez

Wiegand

2004

The American Journal of Surgery

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Computer-Assisted Instrumentation during Endoscopic Transaxillary First Rib Resection for Thoracic Outlet Syndrome: A Safe Alternate Approach

Cited by 5 publications

References 0 publications

Thoracic outlet syndrome: A neurological and vascular disorder

Thoracic outlet syndrome: A neurological and vascular disorder

Experimental model as training tool in endoscopic axillary dissection

Robotics in vascular surgery

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